PAs in Orthopedic Surgery Growing in Numbers & Responsibilities

Many orthopedic practices are feeling the pinch of supply-and-demand, which may contribute to healthier bottom lines but not necessarily healthier, satisfied patients. As the aging baby boomer population is lining up for arthroplasty and other services and newly insured patients are being added to the healthcare system under the Accountable Care Act, orthopedic surgery is a specialty that will feel the squeeze of increasing demand. In fact, the federal Health Resources and Services Administration (HRSA) predicts a shortage of more than 6,000 orthopedic surgeons by 2020.

This explains why physician assistants are in great demand in orthopedic surgery and are working in every orthopedic subspecialty, in every clinical setting.

According to the National Commission on Certification of Physician Assistants (NCCPA) there are more than 8,500 certified PAs working in orthopedic surgery today, which is almost 9 percent of the total number of the nation's 96,000 certified PAs. And those numbers are poised for tremendous growth, with the number of PA educational programs on the verge of increasing by over 30 percent in the next three to five years alone based on the number of new programs seeking accreditation right now.As a certified physician assistant for the sports medicine service at Massachusetts General Hospital, I care for patients in the office and operating room, treating patients that include high school and college athletes and weekend warriors. With my supervising physician, we also provide medical care to local professional sports teams.

The medical model of team-based care is fundamental to what PAs do. Our responsibilities are determined by state regulations and the supervising physician. Because PAs work so closely with a physician, trust can grow quickly, allowing us to expand our roles to the limit of our license.

Depending on the surgeon, PAs in our specialty will handle everything from routine office visits to being first assist in the operating room. We see patients in the office autonomously and work them up prior to surgery. We suture tendons, drill tunnels and place anchors. We also manage perioperative care and follow patients to ensure they are complying with DVT prophylaxis, physical therapy and pain management.

What’s New about PAs in Orthopedic Surgery?It's increasingly likely that patients will see a PA during their course of treatment. That is one of the biggest changes for PAs in this specialty. Today, patients generally understand who we are and what we do. Our office staff does a great job of informing patients that a PA is a highly skilled provider who can diagnose and treat a new patient — often a month or more sooner than a physician. I rarely have to explain the PA role to a patient anymore.

Another change is that physicians have grown more comfortable relying on PAs. In fact, a growing trend is that physicians now hire a PA privately because they know that the PA can take many duties off their schedule, decrease their out-of-balance workload and open up access for new patients.

In addition, as more patients require services, there will be more PAs than physicians entering the healthcare system in the next 10 years for two reasons: cost and time.

The cost of becoming a surgeon continues to escalate due to malpractice insurance, overhead and time in school, while the cost of becoming a PA is relatively stable.

PA education is masters-level, averaging 27 months but still, significantly shorter than an orthopedic surgeon's education. Once PAs graduate they have to pass NCCPA's national certifying exam to be eligible for a state license. PAs maintain certification through ongoing continuing medical education (CME) and by passing NCCPA's recertification exam every six to 10 years.

PAs are trained as generalists, but two-thirds of them go on to work in specialty areas. We learn much about what we know in a specialty by training with our supervising physicians, and PAs' roles grow as physicians get comfortable with our skills and abilities.

A relatively new development for PAs in orthopedic surgery is an additional credential that NCCPA began offering in 2011. Called the Certificate of Added Qualifications (CAQ) in Orthopedic Surgery, it recognizes a PA for expertise in and commitment to the specialty. There are four requirements for a PA to earn the CAQ: two years' experience in orthopedic surgery, 150 hours of CME focused in the specialty, a physician attestation, and the passing of the national Orthopedic Surgery Specialty Exam. This additional credential sets apart a PA that is dedicated to the specialty and has an advanced knowledge base of orthopedic procedures.

A major shift for the PA profession is that more PAs are earning MBAs and sitting in the "big chairs" at their institutions, as administrators involved in shaping policy for large healthcare systems. Hospitals and physicians want the PA "voice" on how to implement team care to streamline processes and improve quality outcomes.

For example, at New York's Hospital for Special Surgery (HSS) Peter Grimaldi, PA-C, MS, MPT, earned an MBA in Healthcare Administration. As senior director, Peter assists with the management of 92 PAs, and interfaces with another 50 PAs who work privately for physicians or for the Radiology & Imaging service line. The number of PAs in orthopedic surgery at HSS has nearly quadrupled in the last 10 years, and a great deal of Peter's time is focused on strategic planning, policy, process development and operational issues.

The ongoing changes and demands in the health care marketplace continue to highlight the need for highly skilled providers with the knowledge, experience and commitment to meet the needs of patients as well as hospitals and other organizations that employ them. The nation's healthcare system will continue to face challenges ranging from access, to cost, to quantifying quality. Today's PAs have the ability to help organizations meet and exceed those demands.

About the author:Sean Hazzard, PA-C, has over eight years of experience as a PA in sports medicine. He was among the first physician assistants to receive the Certificate of Added Qualification in Orthopedic Surgery.